Healthcare Provider Details

I. General information

NPI: 1306425129
Provider Name (Legal Business Name): ALEX AW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

3 MARYLAND FARMS STE 200
BRENTWOOD TN
37027-5780
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3277
  • Fax:
Mailing address:
  • Phone: 800-348-4565
  • Fax: 888-203-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA179864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: